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Experts raise doubts about medical evidence presented in court

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Experts raise doubts about medical evidence presented in court
Cheshire Police A police mugshot of Lucy LetbyCheshire Police

Senior doctors and scientists have told the BBC they have concerns about how crucial evidence was presented to the jury at Lucy Letby’s trials.

The BBC’s File on 4 has examined how expert witnesses helped to build the case against the former nurse.

The programme raises concerns about how courts grapple with cases of significant medical complexity – with the juries in Letby’s two trials presented with huge amounts of complicated medical evidence relating to each child.

The experts who spoke to the BBC raise questions about the amount of insulin she needed to harm babies in her care, the health condition of one of the babies she was convicted of murdering, and pathology findings presented to the jury.

A public inquiry is under way to establish how Letby was able to murder and injure babies. At its opening Lady Justice Thirlwall was scathing about those who have questioned the verdicts, saying this was causing “enormous additional distress to the parents”.

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Last month some of the families of the babies gave evidence at the inquiry.

Each of the experts interviewed by File on 4 acknowledge how difficult it must be for the families to hear doubts raised about the trials. However, they say they feel so strongly about the evidence they felt compelled to speak out.

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BBC File on 4 examines some of the most contentious statistical, scientific and medical evidence in the Lucy Letby trial. Listen to Lucy Letby: The Killer Questions

Available now on BBC Sounds and on BBC Radio 4 on Tuesday 1 October at 20:00, and Wednesday 2 October at 11:00.

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More than 100 days of complex evidence was heard during Letby’s first trial, which ended in August 2023. She was found guilty of murdering seven babies and trying to kill six others between June 2015 and June 2016 at the Countess of Chester Hospital.

In a second trial held this year, a different jury found Letby guilty of attempted murder – after the first jury failed to reach a verdict. She is serving 15 whole-life sentences and four judges have dismissed her attempt to appeal these convictions.

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Most of the experts File on 4 spoke to were not present at the trials, and they don’t offer an opinion on her guilt. They have studied key medical evidence presented in court. Their concerns – that some of it was misinterpreted – form part of the growing speculation around her convictions.

It comes after Letby’s new lawyer, Mark McDonald, told the BBC he plans to take her case to the Criminal Cases Review Commission (CCRC), which investigates alleged miscarriages of justice.

Insulin evidence

At her first trial Letby was found guilty of attempting to murder two babies – referred to in court as Baby F and Baby L – by adding insulin to intravenous feed bags.

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The prosecution said both babies were doing well until Letby attacked them, and that it was suspicious she later searched for the parents on Facebook.

The prosecution alleged it would have taken only a few drops to poison each baby, but File on 4 has spoken to a team of mechanical and chemical engineers who disagree – and who are speaking about their calculations for the first time.

Prof Geoff Chase, from the University of Canterbury in New Zealand, has been modelling how insulin works in pre-term babies for more than 15 years. He worked with chemical engineer Helen Shannon on a mathematical model that calculated significantly higher quantities of insulin would be needed to harm babies F and L, and to generate insulin levels seen in their test results. In the case of Baby L they calculated it could be as much as 20-80 times more.

There was no evidence in the trial to suggest significant quantities of insulin had gone missing on the ward.

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Speaking to File on 4, another expert expressed concerns about the use of the same blood test results at the trial – something others have questioned in the media.

Dr Adel Ismail – a world-leading expert in the test – told the BBC he believes the immunoassay blood test can produce misleading results.

“In my research, I found the error rate is one in 200,” he said, and added that a second, confirmatory test in such cases was “absolutely vital”. In the case of Baby F and Baby L follow-up tests were not carried out by the lab.

Some experts, however, say the tests are good enough to rely on one set of results. The hospital didn’t order further tests because both babies recovered soon after.

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The X-ray and Baby C’s collapse

Letby was also found guilty of murdering a baby referred to in court as Baby C.

Key to the case was an X-ray taken on 12 June – it was referred to repeatedly during the first trial. In pre-trial reports two prosecution witnesses said it showed the baby had a swollen stomach “most likely due to deliberate” pumping of air into his feeding tube.

However, neonatologist Dr Michael Hall – who has spoken publicly about his concerns before, and has written to the chair of the public inquiry – told the BBC: “There are a number of possible explanations for there being excess gas there.”

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Dr Hall, who was consulted by the defence but never called to give evidence, said it is likely to have been caused by the respiratory support the baby was receiving and said the X-ray suggested there was a bowel obstruction.

Letby was not working on the day the X-ray was taken and had not been on shift since before the baby was born – information the jury heard in her first trial. Letby’s former barrister Ben Myers also highlighted these details in his closing argument.

In his summing up the judge made clear to the jury this X-ray had been taken the day before Baby C collapsed, though he didn’t remind them Letby hadn’t been on shift. At appeal, the prosecution said Letby could have visited the hospital while off shift, but didn’t put forward any evidence that she was there.

The BBC has also spoken to five senior clinicians who reviewed Baby C’s medical notes made public at trial – although only one had access to the baby’s complete medical history. They all noted the baby was high risk and should have been in a higher level unit.

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Prof Colin Morley, a retired professor of neonatology from the University of Cambridge, told File on 4 he was “very confident” Baby C died of natural causes.

At the trial, the X-ray was not the only evidence used to convict Letby on this charge. The prosecution argued text messages showed she was desperate to get into the room where Baby C was being treated, even though she wasn’t his designated nurse. Another nurse said she found Letby standing over the baby’s cot when he collapsed. After he died, Letby again searched for his parents on Facebook.

Liver damage

Baby O was one of triplet brothers born in good condition in June 2016. He was stable, Letby’s first trial was told, until the afternoon of 23 June when he suffered a “remarkable deterioration” and later died.

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The pathologist for the prosecution, who reviewed the case, said he believed Baby O had suffered an “impact injury” to his liver akin to a road traffic collision.

There was other evidence used to convict Letby of Baby O’s murder. She objected to the baby being moved to another area of the unit to be more closely monitored. She was accused of falsifying medical notes, and there was a rash which prosecution experts said was consistent with air being injected into the baby’s veins.

However, a leading senior perinatal pathologist told File on 4 she agrees with the original post-mortem on Baby O – that his liver injury and death were by natural causes.

The pathologist – who asked not to be identified because of the controversial nature of Letby’s case – said she has seen this kind of liver damage at least three times in her career. Each time there were natural causes.

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None of the experts who spoke to File on 4 made any evaluation of Letby’s guilt or otherwise, but added their concerns to growing speculation about how complex medical evidence was presented at her trials.

In August, 24 experts wrote to the government to share their concerns over the way statistics and the science around newborn babies was presented to the jury at the former nurse’s first trial.

The Crown Prosecution Service told the BBC: “Two juries and three appeal court judges have reviewed the evidence against Lucy Letby, and she has been convicted on 15 separate counts following two separate trials.”

It said in May the Court of Appeal dismissed Letby’s leave to appeal on all grounds – rejecting her argument that expert prosecution evidence was flawed.

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This is a distressing case, so if you – or someone you know – need help after reading about it, the details of organisations offering assistance can be found on the BBC Action Line.

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Rotana to launch 43 new properties across the MENAT region by 2026

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Rotana to launch 43 new properties across the MENAT region by 2026

Rotana, one of the leading hotel management companies in the Middle East, Africa, Eastern Europe, and Türkiye (MENAT), will be developing 43 new properties in 26 cities in the Middle East, Africa, Europe, and Türkiye by 2026

Continue reading Rotana to launch 43 new properties across the MENAT region by 2026 at Business Traveller.

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New UK law on tipping in pubs, hairdressing salons and cafes comes into force today

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New UK law on tipping in pubs, hairdressing salons and cafes comes into force today


Leaders in the hospitality sector have warned that this measure could impose an "additional cost" on already struggling businesses.

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Shy Creatures by Clare Chambers — art and psychiatry in postwar Britain

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Nobody in Helen Hansford’s family understands why she’d accept a job at Westbury Park, not least as an art therapist. But Dr Gil Rudden, one of the mental-health facility’s senior psychiatrists, understands completely. The two are initially attracted by a mutually progressive attitude towards mental health and to the patients in their respective care. It’s 1964, and homosexuality, for example, is still considered an illness to be treated. As Gil points out, “most so-called mental disorders are just behaviour that society doesn’t approve of.”

Within weeks their fledgling relationship has become all-consuming. Although, married as Gil is with two children, “he could hardly be more unavailable.” Their connection deepens when they’re called out to a dilapidated home where an elderly woman, Louisa, lives in squalor with her adult nephew William. The latter either cannot or will not speak, and he doesn’t appear to have left their Croydon house in two decades. Louisa and William Tapper are Westbury Park’s newest patients, and to Helen’s delight, it emerges that William possesses a rare artistic talent.

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Shy Creatures establishes a laser-like focus on extraordinary lives set against the suburban postwar setting, just as she did in her novel Small Pleasures. That 2020 novel was a “personal resurrection story” for Chambers, some of whose previous books were out of print when it was published to wide acclaim. Now, her latest and 10th novel is published to real demand.

Chambers’ dialogue is particularly strong, as is the precise study of human interactions in all their subtlety and shades. Her world-building speaks to extensive research but displays a light touch, imbuing the atmosphere of the story and its inhabitants with the smoke of Woodbines, the soot of coal scuttles and bomb shelters not long out of commission. The Tappers’ house reveals “a long, dark hallway with bulging wallpaper the colour of raw liver”, while public attitudes are laid bare in all their double standards: Helen hears with a “jolt” the “venom” directed at Christine Keeler, the “vitriol her parents reserved for women who took up with married men”. Woven throughout is the risk of the facility’s closure, as the mid-20th-century drift towards de-institutionalisation begins with patients soon to be “turf[ed] back out” in a “revolving-door effect”.

Book cover of ‘Shy Creatures’

We follow Helen as she attempts to unravel the mystery of the silent patient. Interspersed among her chapters are those of William himself. “It’s difficult to get an accurate picture of their life together,” Gil observes of the man and his aunt. “Was he a prisoner or a recluse? Was she?” This picture develops gradually via snapshots of formative experiences, moments of fear and ostracisation, past friendships, school days. The central mystery hinges on William’s past and the origin of his impressive creative skill. His drawings are born from quiet contemplation and observation — in much the same way as he, at Westbury Park, is now observed. Structurally, however, while the first two-thirds linger compellingly on vignette-like scenes, taking their time, the final chapters feel rushed and too busy with revelation.

William’s past, as it unfolds, enables Helen to react against the corset-like confines of a society that turns inward all too often and shuts its doors, one where the threat of “busybodies” and “interference” are a constant fear, and “nervous collapse” the ultimate shame. Through subplots involving her niece, Lorraine, and a lonely downstairs neighbour — “of whom she knew so little, and the other inhabitants of the flats, strangers all” — she observes the “curious bond” needed to create true community and, ultimately, a sense of the bonds she herself must break or make to find her own.

Shy Creatures by Clare Chambers Weidenfeld & Nicolson £20, 390 pages

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Key Benefits and Risks to Consider

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What is the Average Credit Score in the UK

Luxury real estate has an undeniable appeal, whether it is for the prestige, the lifestyle, or the investment potential. For example, real estate in Limassol offers stunning waterfront properties with breathtaking views and proximity to vibrant city life, making it an attractive option for those looking to combine luxury living with a solid investment.

But before you dive headfirst into this high-end market, there are some important factors to consider. Yes, luxury real estate can offer significant financial rewards, but it’s not without its challenges. Let’s break it down with a touch of practicality.

What Makes a Property “Luxury”?

Essentially, it refers to properties at the top end of the market in terms of price, features, and location. True luxury homes often include a prime location (think beachfront or city centre), top-quality finishes, and unique design elements.

The word “exclusive” is key—whether it’s a gated community, a secluded mansion, or a penthouse in a highly sought-after building, luxury real estate is meant to offer something rare and coveted.

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The Financial Benefits of Investing in Luxury Real Estate

Capital Appreciation

Luxury properties often hold their value well—especially in prime locations with limited availability. Over time, these homes can appreciate significantly, making them an attractive long-term investment. This is particularly true in markets with high demand and little room for expansion.

Rental Income Potential

A major draw of luxury real estate is the potential for rental income. High-net-worth renters often seek premium properties for short or long-term stays—vacation homes, corporate rentals, or even long-term residences. For instance, if you own a villa in a vacation hotspot like Cyprus or Ibiza, you can charge top dollar for weekly rentals during peak season.

Tax Benefits

In some places, you may be able to deduct mortgage interest, property taxes, and even certain maintenance costs. Additionally, if you rent out your property, you might qualify for further tax breaks related to rental expenses and depreciation.

Lifestyle Benefits of Owning Luxury Real Estate

Luxury real estate isn’t just about making smart financial decisions—there’s a lifestyle element to it, too. You’re not just buying a house; you’re buying into a certain way of living.

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Prestige and Social Status

Owning a luxury property is often seen as a marker of success. It’s a status symbol that reflects personal achievement and financial stability. Beyond that, living in a high-end home in a prestigious neighbourhood often comes with certain social advantages, whether it’s networking opportunities, invitations to exclusive events, or simply the sense of pride that comes from knowing you’ve “made it.”

Top-Notch Amenities

Luxury properties are synonymous with luxury amenities. We’re talking infinity pools, private gyms, gourmet kitchens, smart home systems, movie theatres, and sometimes even wine cellars or indoor basketball courts. These homes are designed for people who appreciate the finer things in life and want access to every convenience without ever leaving the house.

Customization and Uniqueness

One of the most satisfying aspects of owning luxury real estate is the level of customization available. Many luxury properties are built or renovated to suit the owner’s specific tastes, meaning you get to live in a home that’s truly your own. Whether you want an outdoor kitchen for entertaining, a sprawling garden, or cutting-edge design, a luxury home allows you to create the perfect space tailored to your lifestyle.

Risks of Investing in Luxury Real Estate

Of course, no investment is without its risks, and luxury real estate is no exception. While the rewards can be substantial, it’s important to go into the process with your eyes wide open.

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Market Volatility

Unlike the mid-tier market, which tends to move more gradually, high-end real estate can be significantly affected by economic shifts, political changes, and even global events. During a recession or housing market crash, luxury properties can take longer to sell, and buyers may have to accept lower-than-expected offers.

High Maintenance Costs

Large gardens, pools, and specialized systems like smart home technology or custom lighting require constant upkeep, and you’ll likely need to hire professionals to maintain everything. Also, insurance premiums on luxury homes are typically higher, especially if the home has unique or high-risk features (like waterfront access or a large collection of rare art).

Illiquidity

Luxury real estate isn’t the most liquid asset. It can take months, or even years, to sell a high-end property, especially in a slow market. This means that if you need to access your capital quickly, selling a property might not be the best option.

aerial photograph of building near body of water

Credit: Anthony DELANOIX on Unsplash

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How to Approach Investing in Luxury Real Estate

If you’re seriously considering investing in high-end real estate, here are some practical tips to help guide your decision:

  • Understand the market: Before making any investment, spend time learning about the specific market you’re interested in. Is it a buyer’s market or a seller’s market? Are property values on the rise or in decline? You’ll want to have a clear picture of the current market trends.
  • Location is everything: A high-end property in a desirable neighbourhood will always hold more value than a comparable property in a less popular area.
  • Think long-term: Real estate is generally a long-term investment. Don’t expect to flip a property for quick cash unless you’re extremely lucky or have a keen understanding of market timing.

Wrapping It All Up

Investing in luxury real estate offers a blend of financial rewards and lifestyle benefits that can be highly attractive, but it’s important to weigh the risks carefully. The potential for capital appreciation and rental income is significant, but so are the maintenance costs and market volatility.

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Israel begins ground offensive against Hezbollah in southern Lebanon

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Israel begins ground offensive against Hezbollah in southern Lebanon

Israeli ground forces crossed into southern Lebanon early Tuesday, marking a significant escalation of an offensive against Hezbollah militants and opening a new front in a yearlong war against its Iranian-backed adversaries. (AP video by Sam McNeil)

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Adnoc agrees to buy Germany’s Covestro in €14.7bn deal

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Abu Dhabi’s national oil company has agreed a €14.7bn deal to buy German chemicals group Covestro in one of the largest European takeovers this year.

Adnoc, which has been pursuing Covestro since last year, has offered €62 per share for the German company. It will also inject €1.17bn of new money into the chemicals group.

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Adnoc chief executive Sultan Ahmed Al Jaber said: “As a global leader and industrial pioneer in chemicals, Covestro brings unmatched expertise in high-tech speciality chemicals and materials, using advanced technologies including AI.”

The two sides have been in talks since Adnoc made an initial informal offer in September 2023.

Covestro initially rejected offers of below €60 a share and then debated whether its sustainability drive would be undermined by ownership by Adnoc. 

Markus Steilemann, chief executive of Covestro, said: “With Adnoc International’s support, we will have an even stronger foundation for sustainable growth in highly attractive sectors and can make an even greater contribution to the green transformation.”

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Adnoc said it had asked the Covestro management team to stay on after the completion of the deal. It also said it would support “the commitments made to Covestro’s employees and has undertaken to uphold existing works council, collective bargaining, and similar agreements”.

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